Theoretical Foundation

Theoretical Foundations • Theoretical frameworks – allow the systematic organization of knowledge – guide data collection – provide explanations for assessed behaviors – guide care plan development – provides rationales for interventions and – determine evaluation criteria – Guide research by providing

Theoretical Foundations Psychosexual- Psychoanalytical Theory

Sigmund FREUD

Psychosocial Theory

Erik ERIKSON

Cognitive Theory

Jean PIAGET

Interpersonal Theory

Harry Stack Sullivan

Moral Theory

KOHLBERG

Spiritual Theory

FOWLER

Theoretical Foundations Behavioral Theories

Pavlov and Skinner

Humanistic Theories

Maslow and Carl Rogers

Psychobiology theory

Neuroanatomy and physiology

Theories of Personality development • Freud’s Psychoanalytic theory • Erikson’s Psychosocial theory • Sullivan’s interpersonal theory • Piaget’s Cognitive theory • Fowler’s Spiritual theory • Kohlberg’s Moral theory

Psychosexual/Psychoanalyti cal • This theory supports the notion that EVERY human behavior is caused and can be explained

• Freud believes that “repressed”

sexual urges, desires, impulses or drives motivated much human behavior

Psychosexual/Psychoanalyti cal Components of Personality 2. ID- part of a person that reflects BASIC or innate DESIRES, INSTINCT and SURVIVAL impulses 3. EGO- represents the REALITY aspect 4. SUPER-EGO- part that reflects MORALITY and ethical concepts,

Psychosexual/Psychoanalyti cal Personality Stages and Functional Awareness 2. Conscious – perceptions, thoughts and emotion that exist in the person’s awareness 3. Pre-conscious/SubconsciousThoughts and emotions not currently in awareness but can be recalled with effort 4. Unconscious- thoughts, drives

Psychosexual/Psychoanalyti cal According to this theory, much of our behavior is motivated by our SUBCONSCIOUS thoughts or feelings

Psychosexual/Psychoanalyti cal Five Stages of psychosexual development 2. Oral 3. Anal 4. Phallic or Oedipal 5. Latency 6. Genital

Psychosexual/Psychoanalytic al Phase Oral Anal Phallic

Age 0-18 months 1½-3 years 3- 5 years

Focus Site of gratification: Mouth Site of gratification: Anus Site of gratification: Genitals

Latenc 6- 12 years Site of gratification: (School y Activities) Genital 12 & above Site of gratification: Genitals

Psychosexual/Psychoanalytic al Phase Oral Anal Phallic

Age 0-18 months 1½-3 years 3- 5 years

Focus Major task: Weaning Major task: Toilet training

Major task: Oedipal & Electra complex 6- 12 years Major task : School activities

Latenc y Genital 12 & above Major task: Sexual intimacy

Psychosexual model (Freud) 1. Oral a. 0-18 months b. Pleasure and gratification through mouth c. Behaviors: dependency, eating, crying, biting d. Distinguishes between self and mother e. Develops body image, aggressive drives

Psychosexual model (Freud) 2. Anal a. 18 months - 3 years b. Pleasure through elimination or retention of feces c. Behaviors: control of holding on or letting go d. Develops concept of power, punishment, ambivalence, concern with cleanliness or being dirty

Psychosexual model (Freud) 3. Phallic/Oedipal a. 3 - 6 years b. Pleasure through genitals c. Behaviors: touching of genitals, erotic attachment to parent of opposite sex d. Develops fear of punishment by parent of same sex, guilt, sexual identity

Psychosexual model (Freud) 4. Latency a. 6 - 12 years b. Energy used to gain new skills in social relationships and knowledge c. Behaviors: sense of industry and mastery d. Learns control over aggressive, destructive impulses

Psychosexual model (Freud) 5. Genital a. 12 - 20 years b. Sexual pleasure through genitals c. Behaviors: becomes independent of parents, responsible for self d. Develops sexual identity, ability to love and work

Psychosexual/Psychoanalytic al Transference and Countertransference  TRANSFERENCE is the clients feeling toward nurse arising from unconscious experiences with early significant others  COUNTER TRANSFERENCE is the nurse’s feelings toward the patient arising also form previous experiences

Psychosexual/Psychoanalytic al The Freudian View of Mental Illness  All behavior has meaning  Mental illness and manifestations are caused by unconscious INTERNAL conflict arising from unresolved issues in early childhood  Ego defenses are utilized to relieve inner tension

Psychosocial Theory  Theory

that focuses on developmental task, focuses on EGO as this develops from social interaction  The developmental tasks are sequential and depend on prior successful mastery  An individual who fails to “master” the task at appropriate age may return to work on

Psychosocial Theory Use of the theory in Nursing  Assessment can be done focusing on the psychosocial development at specific age  Appropriate interventions can be selected based on task  Nurses can promote healthy behaviors and encourages hope that re-learning is possible

Erikson’s Psychosocial theory  Trust

versus mistrust  Autonomy versus shame and doubt  Initiative versus guilt  Industry versus inferiority  Identity versus role confusion  Intimacy versus isolation  Generativity versus stagnation  Ego integrity versus despair

Psychosocial Model (Erikson) 1. Trust vs mistrust a. 0 - 18 months b. Learn to trust others and self vs withdrawal, estrangement

2. Autonomy vs shame and doubt a. 18 months - 3 years b. Learn self-control and the degree to which one has control over the environment vs compulsive

Psychosocial Model (Erikson) 3. Initiative vs guilt a. 3 - 5 years b. Learn to influence environment, evaluate own behavior vs fear of doing wrong, lack of selfconfidence, over restricting actions

4. Industry vs inferiority a. 6 - 12 years b. Creative; develop sense of competency vs sense of inadequacy

Psychosocial Model (Erikson) 5. Identity vs role confusion a. 12 - 20 years b. Develop sense of self; preparation, planning for adult roles vs doubts relating to sexual identity, occupational career

6. Intimacy vs isolation a. 18 - 25 years b. Develop intimate relationship with another; commitment to career vs

Psychosocial Model (Erikson) 7. Generativity vs stagnation a. 21 - 45 years b. Productive; use of energies to guide next generation vs lack of interests, concern with own needs

8. Integrity vs despair a. 45 years to end of life b. Relationships extended, belief that own life has been worthwhile vs lack of meaning of one’s life, fear of

Interpersonal theory 

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This concept focuses on interaction between an individual and his environment Personality is shaped through “interaction” with significant others We internalize approval or disapproval form our parents

Interpersonal theory Personality has three SELF-SYSTEM 1. “Good Me” develops in response to behaviors receiving approval by parents/SO 2. “Bad Me” develops in response to behaviors receiving disapproval by parents/SO 3. “Not Me” develops in response to behaviors generating extreme anxiety in parents/SO and this is denied as part of oneself

Interpersonal theory Mental Health is Viewed as: 2. Related to conflict or problematic interpersonal relationships 3. Past relationships, inappropriate communication and current relationship crisis are etiologic factors of mental illness

Interpersonal theory Treatment of Mental illness:  Focuses on anxiety and its causes  Therapeutic relationship with client that is active and participative  Feelings and emotions are verbalized by the clients to modify problematic relationships

Interpersonal theory Usefulness in Nursing  Nurse and client can participate in and contribute to the relationship that is therapeutic  This relationship can be used as a corrective interpersonal experience  Anxiety management

Interpersonal Model (Sullivan) 1. Infancy a. 0 - 18 months b. Others will satisfy needs

2. Childhood a. 18 months - 6 years b. Learn to delay need gratification

3. Juvenile a. 6 - 9 years b. Learn to relate to peers

Interpersonal Model (Sullivan) 4. Preadolescence a. 9—12 years b. Learn to relate to friends of same sex

5. Early adolescence a. 12—14 years b. Learn independence and how to relate to opposite sex

6. Late adolescence a. 14—21 years b. Develop intimate relationship with person of opposite sex

Cognitive Theory 

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This theory focuses on the inborn development of thinking ability from infancy to adulthood A person is born with a tendency to organize and to adapt to their environment Mental illness is not directly discussed

Cognitive Theory Usefulness of Cognitive theory in Nursing 2. This provides an understanding how an individual think and communicate. Nurse can provide intervention accordingly 3. Nursing interventions should be congruent to the age-specific cognitive level 4. Teaching strategies are modified according to cognitive process

Piaget  

Sensori-motor (birth to 2 ) Pre-operational (2-7)  

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Preoperational preconceptual (2-4) Preoperational intuitive (4-7)

Concrete operational (7-12) Formal operational (12 to adulthood)

Cognitive Theory (Piaget) A. 0 - 2 years: sensorimotor -reflexes, repetition of acts B. 2 - 4 years: preoperational/preconceptual -no cause and effect reasoning; egocentrism; use of symbols; magical thinking C. 4 - 7 years: intuitive/preoperational -beginning of causation

Cognitive Theory (Piaget) D. 7 - 11 years: concrete operations - uses memory to learn - aware of reversibility E. 11 - 15 years: formal operations -reality, abstract thought -can deal with the past, present and future

Behavioral Theory 

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This concept describes a person’s function in terms of identified BEHAVIORS People learn to be who they are Behavior can be observed, described and recorded Behavior is subject to reward or punishment Behavior can be modified by changing environment

Behavioral Theory 

The Classical Conditioning by Pavlov 

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Learning can occur when a stimulus is paired with an unconditioned response Conditioned responses happens when stimulus is present Acquisition – gain of learned response Extinction – loss of learned response

Behavioral Theory 

The Operant Conditioning by Skinner     

Rewards and punishments are utilized Positive reinforcement- rewards Negative reinforcementPositive punishment Negative punishment- withdrawing reward

Behavioral Theory Mental Illness is viewed as:  Mal-adaptive BEHAVIORS are learned through classical and operant conditioning  Mal-adaptive behaviors can be changed by altering environment

Behavioral Theory Application to Nursing 2. The nurse assess both adaptive and ,aladaptive behaviors 3. The nurse and client collaborate in identifying behaviors that need to change 4. Behavioral modification techniques are utilized by the nurse in the treatment of mental illness

Humanistic theory 

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Human nature is positive and growth centered and existence involves search for meaning and truth Maslow’s theory of Needs are organized in a hierarchy

Humanistic theory Mental illness in this framework 2. The failure to develop one’s FULL potential leads to poor coping 3. Lack of self awareness and unmet needs interfere with feelings of security 4. Fundamental human anxiety is fear of death which leads to existential anxiety

Humanistic theory Application of the theory to Nursing 2. NCR is based on positive regard, respect and empathy 3. Nurses assess the spiritual aspects of the client including religion, love and relationships 4. Through reflective listening and emphatic responses, the nurse helps the client gain self-understanding

KOHLBERG’S STAGES OF MORAL DEVELOPMENT

PRECONVENTIONAL LEVEL  

Stage 1 Age 2-3 Description:  Punishment or obedience (heteronomous morality)  A child does the right things because a parent tells him or her to avoid punishment

PRECONVENTIONAL LEVEL  

Stage 2 Age : 4-7 Description:  Individualism  Child carries out actions to satisfy own needs rather than society’s. The child does something for another if that person does something for him in return

CONVENTIONAL LEVEL level 2  

Stage 3 Age : 7-10 Description:  Orientation to interpersonal relations of mutuality  A child follows rules because of a need to be a good person in own eyes and in the eyes of others

CONVENTIONAL LEVEL level 2  

Stage 4 Age : 10-12 Description:  Maintenance of social order, fixed rules and authority  Child follows rules of authority figures as well as parents to keep the system working

POSTCONVENTIONAL LEVEL level 3  

Stage 5 Age :older than 12 Description:  social contract, utilitarian law making perspective  child follows standards of society for the good of all people

POSTCONVENTIONAL LEVEL level 3  

Stage 6 Age :older than 12 Descriptions:  universal ethical principle orientation  child follows internalized standards of conduct